title: Use of porcine acellular dermal matrix in revisionary cosmetic breast augmentation.
abstract: BACKGROUND
  Aesthetic breast augmentation can be fraught with postoperative complications, particularly capsular contracture (CC), skin surface irregularities, and implant or inframammary fold malposition. Similar complications have been addressed successfully in reconstructive breast surgery with acellular dermal matrix (ADM) products.
  
  
  OBJECTIVE
  The authors present their initial experience with porcine ADM (PADM) in aesthetic breast augmentation.
  
  
  METHODS
  Retrospective chart review was performed for 93 consecutive patients (179 breasts) who underwent revisionary cosmetic breast augmentation with or without mastopexy between May 2009 and September 2012. Porcine ADM (Strattice; Lifecell Corp, Branchburg, New Jersey) was placed bilaterally in 74 patients and unilaterally in 19 patients. All patients were operated upon by 1 surgeon (J.N.P.). Product use description and complications were recorded, including infection, extrusion, CC, and implant malposition.
  
  
  RESULTS
  Average follow-up was 12 months (range, 1-39 months). There were 2 major complications (1.6% of breasts): an infection in 1 breast that required implant explantation approximately 2 weeks postoperatively and an extrusion that required PADM removal. Two additional patients had high-riding implants resulting from folded PADM that required revision; both cases were corrected by excising the folded PADM segment. Seven other patients required office procedures to correct minor imperfections. Two CC recurrences were suspected (1 patient) in the 76 breasts that underwent capsulectomy and PADM placement.
  
  
  CONCLUSIONS
  Porcine ADM demonstrated great utility as an adjunct in revisionary cosmetic breast surgery. The product helped to provide good aesthetic outcomes with low complication rates. Prospective, randomized trials may prove helpful in defining the role of PADM further in these challenging cases.
authors.affiliation: Department of Plastic Surgery, Cleveland Clinic Florida, Weston, FL, USA. JeremyWhiteMD@gmail.com
authors.forename: Jason N
authors.initials: JN
authors.lastname: Pozner
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: White
authors.forename: Martin I
authors.initials: MI
authors.lastname: Newman
mesh_terms: D062088:Acellular Dermis; D000328:Adult; D000368:Aged; D000818:Animals; D018427:Breast Implants / Q000009:adverse effects*; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D006085:Graft Survival; D006801:Humans; D057910:Implant Capsular Contracture / Q000601:surgery; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps; D013552:Swine; D016896:Treatment Outcome; D055815:Young Adult
keywords: acellular dermal matrix; breast augmentation; breast implant; capsular contracture; malposition; ptosis; revision; rippling